The evaluation of α-tocopherol concentration instead of α-tocopherol:cholesterol ratio in adult cystic fibrosis patients results in the overestimation of vitamin E deficiency
AbstractIntroduction. It has been suggested that serum vitamin E concentrations in CF patients may not properly reflect the body resources of vitamin E. Therefore, we aimed to assess vitamin E status in CF adults relating it to reference values for healthy subjects, also taking into account the α‑tocopherol:cholesterol ratio. Material and Methods. The study group was composed of 33 CF patients − 18 (54.5%) females and 15 (45.5%) males − aged from 18 to 47 years. In all CF patients nutritional status and clinical expression of disease − lung function; Pseudomonas aeruginosa colonization; diabetes; cirrhosis; exocrine pancreatic function and vitamin E supplementation were analyzed. Vitamin E (α‑tocopherol) concentration was assessed by high‑performance liquid chromatography (HPLC).Resuls. CF adults have lower vitamin E concentrations (median: 830 µg/dl vs. 1132 µg/dl, p = 0.00174) and higher vitamin E: cholesterol ratio (median: 7.2 mg/g vs. 6.7 mg/g, p < 0.00001) than healthy subjects. The underlying factor that determines this phenomenon is related to low cholesterol levels observed in CF patients. The percentage of low vitamin E concentrations defined in comparison to healthy Polish peers is considerably higher than low vitamin E:cholesterol ratios (39.4% vs. 21.2%, p = 0.0011). Conclusions. The evaluation of α‑tocopherol concentration instead of α‑tocopherol:cholesterol ratio in CF adults results in the overestimation of vitamin E deficiency. Moreover, there is also potentially a large percentage of individuals with excessive vitamin E body resources. However, this aspect demands further studies.
Sokol RJ. Selection bias and vitamin E and cystic fibrosis. J Pediatr. 2007 May;150(5):e85–e86.
Turck D, Braegger CP, Colombo C, Declercq D, Morton A, Pancheva R, et al. ESPEN‑ESPGHAN‑ECFS guidelines on nutrition care for infants, children, and adults with cystic fibrosis. Clin Nutr. 2016 Jun;35(3):557–577.
Prószyńska K, Bibik K, Książyk J, Lorenc RS, Socha J. Ocena niedoboru witamin A, E, D u dzieci z chorobami wątroby. Pediatria Polska. 1991;LXVI(9–10):19–25.
Huang SH, Schall JI, Zemel BS, Stallings VA. Vitamin E status in children with cystic fibrosis and pancreatic insufficiency. J Pediatr. 2006 Apr;148(4):556–559.
Ford L, Farr J, Morris P, Berg J. The value of measuring serum cholesterol‑adjusted vitamin E in routine practice. Ann Clin Biochem. 2006 Mar;43(Pt 2):130–134.
Rana M, Wong‑See D, Katz T, Gaskin K, Whitehead B, Jaffe A, et al. Fat‑soluble vitamin deficiency in children and adolescents with cystic fibrosis. J Clin Pathol. 2014 Jul;67(7):605–608.
Castellani C, Southern KW, Brownlee K, Dankert Roelse J, Duff A, Farrell M, et al. European best practice guidelines for cystic fibrosis neonatal screening. J Cyst Fibros. 2009 May;8(3):153–173.
Farrell PM, White TB, Ren CL, Hempstead SE, Accurso F, Derichs N, et al. Diagnosis of Cystic Fibrosis: Consensus Guidelines from the Cystic Fibrosis Foundation. J Pediatr. 2017 Feb;181S:S4–S15.
Debray D, Kelly D, Houwen R, Strandvik B, Colombo C. Best practice guidance for the diagnosis and management of cystic fibrosis‑associated liver disease. J Cyst Fibros. 2011 Jun;10(Suppl 2):S29–S36.
Walkowiak J. Faecal elastase-1: clinical value in the assessment of exocrine pancreatic function in children. Eur J Pediatr. 2000 Nov;159(11):869–870.
Walkowiak J, Nousia‑Arvanitakis S, Cade A, Kashirskaya N, Piotrowski R, Strzykala K, et al. Fecal elastase-1 cut‑off levels in the assessment of exocrine pancreatic function in cystic fibrosis. J Cyst Fibros. 2002 Dec;1(4):260–264.
Morton A. Why bother to take vitamins? J R Soc Med. 2011 Jul;104(Suppl 1):S19–S29.
Maqbool A, Stallings VA. Update on fat‑soluble vitamins in cystic fibrosis. Curr Opin Pulm Med 2008 Nov;14(6):574–581.
Sokol RJ, Heubi JE, Iannaccone ST, Bove KE, Balistreri WF. Vitamin E deficiency with normal serum vitamin E concentrations in children with chronic cholestasis. N Engl J Med. 1984 May;310(19):1209–1212.